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Johns Hopkins Advantage MD Select (HMO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Johns Hopkins Advantage MD Select (HMO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on Johns Hopkins Advantage MD Select (HMO) in 2026, please refer to our full plan details page.
Johns Hopkins Advantage MD Select (HMO) is a HMO plan offered by Johns Hopkins Healthcare LLC available for enrollment in 2025 to people living in AL City, AR, FF City, FF, FC City, LO, MA City, PW. The overall rating for this plan is not yet available for 2026.
It's important to know that Johns Hopkins Advantage MD Select (HMO) is a Medicare Advantage (MA) Plan with drug coverage. That means that this plan covers both medical services and prescription drugs.
Key Plan Facts
Below are a few key facts and commonly-asked questions about Johns Hopkins Advantage MD Select (HMO).
Plan Costs:
The cost of a Medicare Advantage Plan is made up of four main parts.
- First, the monthly premium — the amount you pay every month.
- Second, the deductible — the amount you pay out of pocket for covered services before the plan starts paying.
- Third, the copayments and coinsurance — the amounts you pay out of pocket for covered services, usually after meeting the deductible (if applicable). Copays are fixed dollar amounts; coinsurance is a percentage of the cost.
- Fourth, the Out-of-Pocket Maximum — the maximum amount you could have to pay out of pocket in a year. This may be different for in-network and out-of-network services.
For Johns Hopkins Advantage MD Select (HMO), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $0.00. This is the amount you must pay every month.
This plan does not come with a Part B Premium reduction. You must continue to pay your Part B premium.
Deductibles
This plan does not have a health deductible. Your insurance coverage on covered health services will start immediately.
This plan has a $250.00 drug deductible. You will need to pay this amount towards covered prescriptions before your insurance coverage for prescription medications kicks in.
Out-of-Pocket Maximums
This plan has a Maximum Out-Of-Pocket cost of $9250.00 for out-of-network services. You will pay copays, coinsurance, and deductibles toward this amount. Once your total out-of-pocket costs reach $0.00 for in-network covered services, the plan will pay 100% of in-network covered costs for the rest of the year.
You can see below for the coinsurance and specific copayments for in the Additional Benefits section below, or refer to our Plan Details page for more details.
Common Services:
Doctor Visits:
Specialist Visits:
Emergency Room:
Urgent Care:
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Drug Coverage
The Johns Hopkins Advantage MD Select (HMO) plan features a $250 annual drug deductible. Under this plan, Tier 1 preferred generic drugs have no copay for one, two, or three-month supplies at standard pharmacies and standard mail order. Tier 2 generic drugs require a standard copay of $10 for a one-month supply, $15 for a two-month supply, and $20 for a three-month supply. For higher-tier medications filled through standard pharmacies or mail order, costs are based on coinsurance. Tier 3 preferred brand drugs and Tier 4 non-preferred drugs both require a 25% coinsurance for one, two, and three-month supplies. Tier 5 specialty drugs require a 30% coinsurance and are limited to a one-month supply.
Additional Benefits
The Johns Hopkins Advantage MD Select (HMO) plan offers comprehensive medical coverage with many essential services featuring no copay and no coinsurance, including primary care, telehealth visits, and home health services. For inpatient hospital stays, members pay a $350 daily copay for the first five days and no copay for days six through 90, with no coinsurance. Outpatient hospital services require a $325 copay, while specialist office visits and therapy sessions carry copays ranging from $20 to $30 with no coinsurance. Supplemental benefits include dental care, routine hearing exams, and select over-the-counter items with no copay or coinsurance. Routine vision exams feature a $0 to $50 copay, while eyewear is covered with no copay up to a $400 annual maximum. Additionally, durable medical equipment and dialysis services are covered with no copay and a 20% coinsurance.
Inpatient Hospital See details
Johns Hopkins Advantage MD Select (HMO) covers inpatient acute and psychiatric hospital stays with no coinsurance, requiring a $350 daily copay for days 1 through 5 and no copay for days 6 through 90. This benefit is partially covered because additional hospital days, non-Medicare-covered stays, and room upgrades are not covered.
Outpatient Services See details
Outpatient services are covered by Johns Hopkins Advantage MD Select (HMO) with no coinsurance, featuring a $325 copay for outpatient hospital and observation services and a $250 copay for ambulatory surgical center services. Outpatient substance abuse sessions require a $20 copay with no coinsurance, while outpatient blood services are available with no copay and no coinsurance.
Partial Hospitalization See details
Johns Hopkins Advantage MD Select (HMO) covers partial hospitalization services with no copay and no coinsurance, although prior authorization is required.
Ambulance and Transportation Services See details
Johns Hopkins Advantage MD Select (HMO) covers ground and air ambulance services with a $300 copay and no coinsurance, subject to prior authorization. Routine transportation services to plan-approved or health-related locations are not covered under this plan.
Emergency Services See details
Johns Hopkins Advantage MD Select (HMO) covers emergency services with a $115 copay (waived if admitted within 24 hours) and urgently needed services with a $40 copay, both featuring no coinsurance. Worldwide emergency services are partially covered up to a $50,000 maximum with no coinsurance, which includes worldwide emergency care for a $115 copay and worldwide urgent care for a $40 copay, but worldwide emergency transportation is not covered.
Primary Care See details
Johns Hopkins Advantage MD Select (HMO) offers primary care, telehealth, and opioid treatment with no copay and no coinsurance, while specialist, therapy, and psychiatric services require copays between $20 and $30 and no coinsurance. Chiropractic services are partially covered, with a $15 copay and no coinsurance for up to 24 routine visits per year, but other chiropractic services are not covered.
Preventive Services See details
Preventive services are partially covered by Johns Hopkins Advantage MD Select (HMO) with no copay and no coinsurance for covered benefits like annual physical exams and kidney disease education. However, several supplemental services are not covered, including health education, in-home safety assessments, personal emergency response systems, medical nutrition therapy, post-discharge medication reconciliation, re-admission prevention, wigs, weight management, alternative therapies, therapeutic massage, adult day health, nutritional or dietary benefits, palliative care, in-home support, caregiver support, additional smoking cessation, enhanced disease management, telemonitoring, home safety modifications, and counseling.
Hearing Services See details
Hearing services are covered by Johns Hopkins Advantage MD Select (HMO), offering routine exams and unlimited fitting evaluations with no copay and no coinsurance. Prescription hearing aids are partially covered with no coinsurance and a copay ranging from $399 to $699 for up to two aids per year, though OTC, inner ear, outer ear, and over-the-ear hearing aids are not covered.
Vision Services See details
Vision Services are partially covered by Johns Hopkins Advantage MD Select (HMO) with no deductibles, offering one routine eye exam per year for a $0 to $50 copay and no coinsurance, though other eye exam services are not covered. Eyewear is also partially covered with no copay or coinsurance up to a $400 annual maximum for contacts and eyeglasses, but upgrades are not covered.
Dental Services See details
Johns Hopkins Advantage MD Select (HMO) dental services are partially covered with no copay and no coinsurance for covered services, although some require prior authorization. Sub-services that are not covered include other diagnostic dental services, other preventive dental services, maxillofacial prosthetics, and orthodontics.
Home Infusion bundled Services See details
Johns Hopkins Advantage MD Select (HMO) covers home infusion bundled services with no copay, though prior authorization is required. Under this benefit, Medicare Part B chemotherapy and other drugs have no copay and range from no coinsurance to 20% coinsurance, while Part B insulin has a $35 copay and ranges from no coinsurance to 20% coinsurance.
Dialysis Services See details
Dialysis services are covered by Johns Hopkins Advantage MD Select (HMO) with no copay and a 20% coinsurance.
Medical Equipment See details
Johns Hopkins Advantage MD Select (HMO) partially covers medical equipment, offering durable medical equipment, prosthetics, medical supplies, and diabetic therapeutic shoes with no copay and 20% coinsurance. Diabetic supplies are not covered under this benefit, and prior authorization is required for covered items.
Diagnostic and Radiological Services See details
Johns Hopkins Advantage MD Select (HMO) diagnostic and radiological services require prior authorization and are partially covered, as lab services are not covered. Covered diagnostic procedures incur a $20 copay and no coinsurance, outpatient x-rays require a $20 copay plus coinsurance, diagnostic radiological services have a minimum $200 copay and no coinsurance, and therapeutic radiological services require a minimum 20% coinsurance with no copay.
Home Health Services See details
Johns Hopkins Advantage MD Select (HMO) covers Home Health Services with no copay and no coinsurance, although prior authorization is required.
Cardiac Rehabilitation Services See details
Johns Hopkins Advantage MD Select (HMO) offers cardiac rehabilitation benefits with no copay and no coinsurance, but only some services are covered as standard cardiac rehabilitation, intensive cardiac rehabilitation, pulmonary rehabilitation, and SET for PAD services are not covered.
Skilled Nursing Facility (SNF) See details
Johns Hopkins Advantage MD Select (HMO) covers Skilled Nursing Facility (SNF) services with no coinsurance, requiring prior authorization but no prior three-day hospital stay. There is no copay for days 1 to 20 and a $203 daily copay for days 21 to 100, though additional days beyond the Medicare-covered period are not covered.
Other Services See details
Johns Hopkins Advantage MD Select (HMO) partially covers other services, offering acupuncture and over-the-counter (OTC) items with no copay and no coinsurance, while meal benefits are not covered. Acupuncture is limited to 24 treatments per year, and the OTC benefit provides up to $50 every three months for select items.
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